WFNS分级系统修订对动脉瘤性蛛网膜下腔出血患者预后评估意义

发布时间：2018-05-31 00:12

  本文选题：蛛网膜下腔出血 + WFNS分级系统　； 参考：《苏州大学》2015年硕士论文

【摘要】：目的:在第十五届世界神经外科大会上,Sano等人提出了世界神经外科联盟分级系统的修改版本(modified World Federation of Neurological Societies Scale,m-WFNSS)。本研究旨在对比新旧版本WFNS分级系统在动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)患者预后评估方面的临床价值。方法:收集2009年1月至2015年1月在苏州大学附属第二医院神经外科住院,且患病后72小时内行手术治疗的a SAH患者临床资料269例,记录患者年龄、性别、入院时的GCS评分、体格检查(是否存在偏瘫或失语)、并发症及手术方式等结果。患者出院时,用格拉斯哥转归量表(Glasgow Outcome Scale,GOS)评价预后。将登记的患者分为预后不良和预后良好两个亚组,GOS中的死亡、植物生存状态(Vegetable State,VS)、严重残疾定义为预后不良,轻度残疾及康复良好定义为预后良好。用曼-惠特尼u检验(Mann-whitney u test)和χ2检验比较原版世界神经外科联盟分级系统(original World Federation of Neurological Societies Scale,o-WFNSS)和m-WFNSS内部相邻分级水平之间的患者在预后方面是否存在统计学差异;预后相关性分析用spearman检验和logistic回归分析;用接收者操作特征(Receiver Operator Characteristic,ROC)曲线比较o-WFNSS和m-WFNSS评估a SAH患者预后的准确性。结果:在m-WFNSS任何相邻分级水平之间,患者GOS平均值均有显著的统计学差异(P0.05),而o-WFNSS中Ⅱ级和Ⅲ级之间的GOS平均值没有显著的统计学差异(P=0.418);在m-WFNSS中,除了Ⅲ级和Ⅳ级外,其余相邻等级之间的患者预后分布均有显著的统计学差异(P0.05),而o-WFNSS的Ⅱ级和Ⅲ级、Ⅲ级和Ⅳ级之间的患者预后分布无明显的统计学差异(P0.05);Spearman检验和logistic回归分析证明WFNS分级系统与患者预后呈显著负相关,但m-WFNSS内部各分级水平的OR值上升趋势较o-WFNSS明显;ROC曲线分析表明,m-WFNSS和o-WFNSS对患者预后的预测均具有较高的准确性(P0.0001),两者的曲线下面积(Area Under Curve,AUC)分别为0.812、0.807。结论:虽然m-WFNSS仍需进一步改进,但对于神经外科医生,m-WFNSS评估a SAH患者预后比o-WFNSS更简单、可靠。
[Abstract]:Objective: at the 15th World Congress of Neurosurgery, Sano et al proposed a modified version of the classification system of the World Federation of Neurosurgery. The purpose of this study was to evaluate the prognosis of patients with aneurysm subarachnoid hemorrhage (SAH) by using the new and old WFNS classification system. Methods: from January 2009 to January 2015, 269 patients with a SAH who were hospitalized in neurosurgery department of the second affiliated Hospital of Suzhou University and operated within 72 hours after the disease were collected. The age, sex and GCS score of the patients were recorded. Physical examination (presence of hemiplegia or aphasia, complications and surgical procedures, etc. On discharge, Glasgow Outcome scale was used to evaluate the prognosis. The registered patients were divided into two subgroups of poor prognosis and good prognosis: death in GOS, vegetative state of vegetative state, severe disability as poor prognosis, mild disability and good rehabilitation as good prognosis. Mann-Whitney u test (Mann-Whitney u test) and 蠂 2 test were used to compare the prognosis of patients with the original World Federation of Neurological Societies Scaleo-WFNSSSS and the adjacent grading levels within m-WFNSS. The prognostic correlation analysis was performed by spearman test and logistic regression analysis, and the accuracy of o-WFNSS and m-WFNSS in evaluating the prognosis of patients with a SAH was compared with the receiver Operator characteristic curve. Results: there was significant statistical difference in the mean value of GOS between any adjacent grades of m-WFNSS (P 0.05), but there was no significant difference in the mean value of GOS between grade 鈪，

本文编号：1957438